DEP/DUA/1/35/10 (Normalised version)

Mary McIntosh

(1784)

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Mary McIntosh. May 30

Disease of this patient manifestly consists principally in an affection of voice.

And this indeed may say is almost only complaint to which she is subjected.

Besides affection of voice indeed, complains of some pain, immediately above the clavicle.

When however consider that this referred to windpipe, in all probability immediately connected with cause producing affection of voice.

In that case indeed as referable to a fixed cause, might be expected that should be constant & uniform.

On contrary however are informed that aggravated by cough, & by swallowing food.

This however can readily conceive to happen even although fixed cause.

For parts in diseased state not otherwise giving pain, may readily be product of such sensation when exposed either to slight [illegible] or exertion.

Such however must happen, both on coughing, & even on exertion to swallow.

But besides pain referred to windpipe is affected with more considerable pain under sternum.

And this too attacking without any manifest cause.

But notwithstanding this circumstance, am inclined to look upon it, as being also connected, with the affection of voice.

Or at least, diseased state giving that symptom, may be propagated downwards though windpipe.

And thus on any slight irritation, as for example from hardened mucus, spasmodic affection may be induced, by which pain of longer or shorter duration as well as dyspnoea may be occasioned.

Thus then consider all the symptoms which occur here, as either depending on same cause producing affection of speech or as being immediately connected with it.

From this then to give name to affection.

May observe that by nosological¹ writers several genera formed, principal part of which, consists in affection of voice.

Particularly Aphonia Mutitas Paraphonia & Psellismus.

All these genera will find in the Nosology of Dr Cullen.

And whether really to be considered as proper distinct genera or not unquestionably foundation for each.

Of these different genera can have no hesitation in referring this case to that of Paraphonia.

And of all the species best entitled to appellation of Paraphonia rauca.

From this view of the disease will be led to form more favourable opinion than if referred to any other cause.

For most of these at least, more dependent on a fixed cause.

While again the paraphonia rauca chiefly from state of secretion in windpipe.

But though this often, yet by no means always the case.

For even from cold, local affections particularly at the larynx, not unfrequently induced, which give hoarseness of voice, during whole remainder of life.

Will not therefore be surprised if this shall turn out to be the case in present instance.

And the rather to be [feared], both from degree to which has taken place, & from pains with which attended.

But on other hand circumstances in case which would lead us to more favourable opinion.

Age of patient much in favour.

For, at so early a period of life, that system yet subjected to many changes

And from these where all [artificial] means fail, known that cure will often occur even in most obstinate diseases.

But what of still more consequence, is but of short duration.

For at utmost only of six months continuation, which with this affection, cannot be considered as of long standing.

And during that period favourable circumstances have taken place.

For through whole of that time, this disease has by no means continued to an equal degree.

At times even perfectly free from it.

And was only within space of a fortnight, of time that applied for our assistance, that had any return of it.

When probably was affect of some accidental exposure to cold.

And is also a circumstance somewhat in favour of patient that to this cause was originally attributed.

For affection you will observe dated, from wading in a pond of water, by which inferior extremities much chilled.

And though this a cause which might give rise to a local affection, yet most probable, that such only as may soon be removed.

Or that produced affection of voice merely from alteration in secretion of mucus.

And this notwithstanding pain referred both to trachea & breast, may still be at least principal cause of leading symptoms.

Upon whole then case not unfavourable.

At same time recovery more to be looked for from operation of nature than from medical aid.

Yet may have recourse to different practices, with view of accelerating & promoting it.

As such, have with this patient, had recourse to use of an oily mixture.

This indeed, can hardly suppose to act in any other way, than as a demulcent.

And that merely from lubricating fauces & head of Larynx.

This affect however vegetable oil even as diffused in water, well known to produce to a very considerable degree.

And although affect may be extended through whole trachea, yet is principally from larynx & neighbouring parts, that alteration in voice produced.

Hence then even from this medicine, might look for some advantage.

And accordingly in instances of Paraphonia rauca etc often attended with good effects.

On this medicine then is intention to continue patient for some time.

And am in hopes that during use, either from influence of medicine or operation of system itself, shall be able to witness progress to recovery.

If this however not the case only other measures from which probable chance of recovery are those [acting] immediately on seat of disease

With this view nothing would occur as more readily meriting trial, than vapour or steam.

And as such may introduce mere watery vapour By Mr Mudge inhaler, or any similar contraption.

May introduce vapour of more penetrating nature, as for example steams of Aether or of Vinegar.

But in preference to any of these have thoughts of trying another & no less powerful agent.

The drawing viz electric sparks from fauces, & trachea.

For by this, I think hopes that state of secretion at least may be corrected & altered.

But with regard to this as well as other measures must be regulated by state in which shall find patient after trial already begun.

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.